Provider Demographics
NPI:1649236902
Name:BENJAMIN, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 WESTFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:865 WESTFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8901
Practice Address - Country:US
Practice Address - Phone:317-776-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061299A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01061299AOtherINDIANA MEDICAL LICENSE
IN$$$$$$$$$OtherTRICARE
IN000000475987OtherANTHEM
IN200826250Medicaid
IN01061299AOtherINDIANA MEDICAL LICENSE